Daniel Soadava and Samoela Razafindramboho are known as "the mean women" in Antalaha, a small town on the east coast of Madagascar. "Men complain that we are always saying bad things about them," they laugh.
After forming an association with other women, called Femmes Interessee au Development de Antalaha (FIDA), Soadava, a dentist, and Razafindramboho, a teacher, soon learned that women in their region were desperately in need of more information about reproductive health and better access to contraceptives.
"Women in the villages are often forbidden to use contraceptives," said Soadava. "Men want the women to have their children, [but] once the children are born the husbands don't want to take care of them."
Madagascar is one of 12 developing countries receiving support to improve access to contraceptives through the UN Population Fund's (UNFPA) Global Programme to Enhance Reproductive Health Commodity Security, and has been described as a success story. According to UNFPA, the percentage of women using contraceptives rose by 11 percent between 2004 and 2009 to reach 29 percent.
Despite this increase, birth control is still not always available, even in urban areas, and one in four births occurs less than 24 months after the preceding one. This means Madagascar is facing rapid population growth. By 2050 the population is expected to more than double, from 19.5 million to 42.3 million, according to the World Bank.
In Antalaha, FIDA's volunteers met with husbands and discovered that their negative attitudes towards family planning were preventing even those women who could get contraceptives from their local clinic from using them. "The men said that children are a gift of God; others don't want their wives to take contraceptives because it would give them too much sexual freedom. Some believe that the pill will make women sick," Soadava said. "So we held separate meetings with the men to inform them of the benefits of smaller families."
The women in greatest need of FIDA's help were teenage girls. In Madagascar the minimum legal age for women to marry is 14 years, and girls under the age of 18 can be married without giving their consent, providing their parents agree. A 2004 UN report estimated that 34 percent of Malagasy girls between 15 and 19 were married, divorced or widowed, and more than a quarter had at least one child.
"We met a girl in a village who was 18 years old and already had three children. They were from different fathers and none of these men had stayed," Soadava said. "In all, we counted 300 girls in the district who gave birth before they were 18."
With World Bank funding, FIDA has set up a centre where the volunteers give girls information and advice, and even accompany those afraid to go to a doctor by themselves, or to report sexual abuse and violence.
After learning that early pregnancy was often the result of a lack of information, the organization also started broadcasting a radio programme aimed at educating women about their reproductive health and legal rights.
"We broadcast one radio programme about rape, and afterwards three families came to see us," said Soadava. "They knew who had raped their daughters but were scared to sue them. People here are easily intimidated by authorities. We went with them and talked to the prosecutor; now these rapists are behind bars."
Razafindramboho said a faltering school system resulted in some girls giving up on school and falling pregnant, while even those girls who made it to secondary school were vulnerable to the attentions of older men.
"Every day when the Lycee (high school) goes out, you see rich guys in cars waiting for 14-year-old girls. These girls soon have expensive mobile phones, famous brand clothes, and in the end they stop studying. It totally destroys them," she said.
"We try to talk to these men in the radio programme, to tell them that they're corrupting girls who are the same age as their own children, but it doesn't stop," Soadava added.
|Sex for school fees|
|"May you have seven sons and seven daughters"|
|Less is more|
|Ambitious family planning goals|
FIDA also disseminates information on how to prevent sexually transmitted infections (STIs). According to the World Bank, Madagascar has a national HIV prevalence of less than one percent and is considered an anomaly in a region that has been devastated by the HIV epidemic, but other STIs, such as syphilis, are very common. Some cities, like the coastal town of Tamatave, have a syphilis infection rate of nearly 17 percent, among the highest in Africa. The volunteers educate local people about the risk factors - starting sexual relations at a young age, having many sexual partners, and not using condoms consistently - and try to counter the common misconception that STIs are not a serious health problem.
The biggest problem FIDA now faces is lack of funding. The World Bank only covers 60 percent of the organization's costs. "We were supposed to find 40 percent ourselves, but we couldn't. We have some NGOs and associations that help us... but it's not enough," said Razafindramboho.
Madagascar's deepening economic crisis has made funding even harder to come by, but the authorities have not responded to the women's pleas for help. Soadava said, "Until now, they haven't even answered us, when in fact we're doing their job."